WO2016135977A1

WO2016135977A1 - Medical treatment device, method for operating medical treatment device, and therapeutic method

Info

Publication number: WO2016135977A1
Application number: PCT/JP2015/055978
Authority: WO
Inventors: 雅人成澤
Original assignee: オリンパス株式会社
Priority date: 2015-02-27
Filing date: 2015-02-27
Publication date: 2016-09-01
Also published as: JP6440816B2; JPWO2016135977A1; US20170367754A1; CN107405167A; DE112015006004T5; CN107405167B

Abstract

A medical treatment device 1 equipped with: a pair of holding members between which a biotissue portion to be bonded is sandwiched; first and second energy application parts 82, 92 which have been provided to at least one of the two holding members and which, when the portion to be bonded has been sandwiched between the pair of holding members, are in contact with the portion to be bonded and apply energy to the portion to be bonded; and an energy control unit 361 which causes the first and second energy application parts 82, 92 to apply, to the portion to be bonded, high-frequency energy in a first period, ultrasonic energy in a second period, which follows the first period, and heat energy in a third period, which follows the second period.

Description

MEDICAL TREATMENT DEVICE, MEDICAL TREATMENT DEVICE OPERATING METHOD, AND TREATMENT METHOD

The present invention relates to a medical treatment apparatus, a method for operating a medical treatment apparatus, and a treatment method.

2. Description of the Related Art In recent years, development of medical treatment devices that apply energy to a part to be joined in a living tissue (hereinafter referred to as a target part) and join the target part has become active. Such a medical treatment device does not leave a physical object such as a stapler in the living body, and thus has a merit that there is less adverse effect on the human body. On the other hand, the bonding strength is weaker than that of the stapler and the like. Depending on the situation, there are some target parts that cannot be joined, and an improvement in joining strength is desired.
By the way, the extracellular matrix (collagen, elastin, etc.) of a living tissue is composed of a fibrous tissue. For this reason, when joining an object part, it is thought that joining strength improves by extracting an extracellular matrix from an object part, and intertwining the extracellular matrix closely.
And the medical treatment apparatus aiming at improving joining strength paying attention to the said extracellular matrix is proposed (for example, refer patent document 1).
The medical treatment apparatus described in Patent Literature 1 sandwiches a target part with a pair of jaws and applies mechanical vibration to the target part via the pair of jaws (giving ultrasonic energy to the target part). Enhance extraction and mixing of extracellular matrix.

JP 2012-239899 A

By the way, according to the study by the present applicant, it is considered that a plurality of processes such as extraction, agitation, and coagulation are required for the extracellular matrix in order to increase the bonding strength of the target site.
However, in the medical treatment apparatus described in Patent Document 1, it is disclosed that the target parts are joined by applying energy to the target part. However, the control according to the appropriate process order is performed. Otherwise, the desired bonding force may not be achieved. Therefore, the medical treatment device described in Patent Document 1 has a problem that it is difficult to improve the bonding strength.

This invention is made in view of the above, Comprising: It aims at providing the medical treatment apparatus which can improve the joint strength of an object site | part, the operating method of a medical treatment apparatus, and a treatment method. .

In order to solve the above-described problems and achieve the object, a medical treatment apparatus according to the present invention includes at least one of a pair of holding members that sandwich a target region to be joined in a living tissue and the pair of holding members. An energy applying unit that is provided on one holding member and that contacts the target site when the target site is sandwiched between the pair of holding members and applies energy to the target site; and the energy applying unit The high frequency energy is applied to the target part in the first period, the ultrasonic energy is applied in the second period after the first period, and the thermal energy is applied in the third period after the second period. And an energy control unit to be applied.
Further, in the operating method of the medical treatment apparatus according to the present invention, at least one of the pair of holding members in the first period after the target region to be joined in the living tissue is sandwiched between the pair of holding members. A first applying step of applying high-frequency energy from the holding member to the target portion, and a second period after the first period, and the target from at least one of the pair of holding members In a second application step of applying ultrasonic energy to the part and a third period after the second period, heat is applied to the target part from at least one of the pair of holding members. A third application step of applying energy.
Further, the treatment method according to the present invention includes a sandwiching step of sandwiching a target region to be joined in a living tissue with a pair of holding members, and at least one of the pair of holding members in the first period. In a first application step of applying high-frequency energy to the target part, and in a second period after the first period, from at least one of the pair of holding members to the target part. Thermal energy is applied to the target part from at least one of the pair of holding members in a second application step of applying ultrasonic energy and a third period after the second period. And a third granting step.

According to the medical treatment device, the operation method of the medical treatment device, and the treatment method according to the present invention, it is possible to improve the bonding strength of the target part.

FIG. 1 is a diagram schematically showing a medical treatment apparatus according to Embodiment 1 of the present invention. FIG. 2 is a block diagram showing a configuration of the control device shown in FIG. FIG. 3 is a flowchart showing the joining control by the control device shown in FIG. FIG. 4 is a diagram showing the behavior of the impedance of the target part calculated after step S4 shown in FIG. FIG. 5 is a diagram showing the behavior of the impedance of the ultrasonic transducer calculated after step S7 shown in FIG. FIG. 6 is a time chart showing the types of energy applied in the first to third periods and the compressive load applied to the target part during the joining control shown in FIG. FIG. 7 is a diagram showing a modification of the first embodiment of the present invention. FIG. 8 is a block diagram showing the configuration of the medical treatment apparatus according to the second embodiment of the present invention. FIG. 9 is a diagram for explaining the function of the locking mechanism shown in FIG. FIG. 10 is a flowchart showing joining control by the control device shown in FIG.

DETAILED DESCRIPTION Hereinafter, modes for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Furthermore, the same code | symbol is attached | subjected to the same part in description of drawing.

(Embodiment 1)
[Schematic configuration of medical treatment apparatus]
FIG. 1 is a diagram schematically showing a medical treatment apparatus 1 according to Embodiment 1 of the present invention.
The medical treatment device 1 applies energy (high-frequency energy, ultrasonic energy, and thermal energy) to a target part (hereinafter, referred to as a target part) of a treatment (joining or anastomosis) in a living tissue, and the target part To treat. As shown in FIG. 1, the medical treatment device 1 includes a treatment tool 2, a control device 3, and a foot switch 4.

[Configuration of treatment tool]
The treatment tool 2 is, for example, a linear type surgical treatment tool for performing treatment on a target site through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes a handle 5, a shaft 6, and a clamping unit 7.
The handle 5 is a portion that the operator holds. The handle 5 is provided with an operation knob 51 as shown in FIG.
The shaft 6 has a substantially cylindrical shape, and one end is connected to the handle 5 (FIG. 1). A clamping part 7 is attached to the other end of the shaft 6. An opening / closing mechanism 10 (see FIG. 1) that opens and closes the first and second holding members 8 and 9 (FIG. 1) constituting the holding portion 7 according to the operation of the operation knob 51 by the operator is provided inside the shaft 6. 2). Further, the handle 5 is connected to the opening / closing mechanism 10, and when the target part is held between the first and

second holding members

8, 9, the opening / closing mechanism 10 is controlled under the control of the control device 3. A motor 11 (see FIG. 2) that increases the compressive load applied to the target part from the first and

second holding members

8 and 9 by being operated is provided. Furthermore, an electric cable C (FIG. 1) connected to the control device 3 is disposed inside the shaft 6 from one end side to the other end side via the handle 5.

[Configuration of clamping part]
The clamping unit 7 is a part that clamps the target part and performs treatment on the target part. As shown in FIG. 1, the clamping unit 7 includes a first holding member 8 and a second holding member 9.
The first and

second holding members

8 and 9 are configured to be openable and closable in the direction of the arrow R1 (FIG. 1) according to the operation of the operation knob 51 by the operator (can clamp the target part).
Specifically, the first holding member 8 is rotatably supported at the other end of the shaft 6 as shown in FIG. On the other hand, the second holding member 9 is fixed to the other end of the shaft 6. That is, in the first embodiment, the first holding member 8 can be opened and closed with respect to the second holding member 9 in accordance with the operation of the operation knob 51 by the operator. For example, when the operation knob 51 moves in the direction of the arrow R <b> 2 (FIG. 1), the first holding member 8 rotates in the direction approaching the second holding member 9. Further, when the operation knob 51 moves in the direction of the arrow R3 (FIG. 1) opposite to the arrow R2, the first holding member 8 rotates in a direction away from the second holding member 9.

The first holding member 8 is disposed on the upper side in FIG. 1 with respect to the second holding member 9. The first holding member 8 includes a first jaw 81 and a first energy application unit 82.
As shown in FIG. 1, the first jaw 81 includes a shaft support portion 811 that is pivotally supported on the other end of the shaft 6 and a support plate 812 that is connected to the shaft support portion 811, so that the operator can operate the operation knob 51. Accordingly, it opens and closes in the direction of arrow R1.

The first energy applying unit 82 applies high frequency energy and thermal energy to the target site under the control of the control device 3. As shown in FIG. 1, the first energy application unit 82 includes a heat transfer plate 821 and a heat generation sheet 822, and the heat generation sheet 822 and the heat transfer surface are provided on a plate surface of the support plate 812 facing the second holding member 9. The heat plates 821 are stacked in this order.
The heat transfer plate 821 is made of, for example, a copper thin plate.
In this heat transfer plate 821, the lower plate surface in FIG. 1 functions as a treatment surface 8211 that comes into contact with the target portion when the target portion is sandwiched between the first and

second holding members

8 and 9. To do.
The heat transfer plate 821 transmits the heat from the heat generating sheet 822 to the target site from the treatment surface 8211 (gives thermal energy to the target site). The heat transfer plate 821 is joined to a high-frequency lead C1 (see FIG. 2) constituting the electric cable C, and will be described later by the control device 3 via the high-frequency lead C1, C1 ′ (see FIG. 2). By supplying high-frequency power to the probe 921, high-frequency energy is applied to the target region.

The heat generating sheet 822 functions as a seat heater. Although not specifically shown, the heat generating sheet 822 has a configuration in which an electric resistance pattern is formed by vapor deposition or the like on a sheet-like substrate made of an insulating material such as polyimide.
The electric resistance pattern is formed along a U shape that follows the outer edge shape of the heat generating sheet 822, and heat generating leads C2 and C2 '(see FIG. 2) constituting the electric cable C are joined to both ends. The electrical resistance pattern generates heat when voltage is applied (energized) by the control device 3 via the heating lead wires C2 and C2 ′.

Although not shown in FIG. 1, an adhesive sheet for adhering the heat transfer plate 821 and the heat generating sheet 822 is interposed between the heat transfer plate 821 and the heat generating sheet 822. This adhesive sheet is a sheet that has high thermal conductivity, withstands high temperatures, and has adhesiveness. For example, this adhesive sheet is formed by mixing ceramics with high thermal conductivity such as alumina and aluminum nitride into epoxy resin. Has been.

The 2nd holding member 9 is provided with the 2nd jaw 91 and the 2nd energy provision part 92, as shown in FIG.
The second jaw 91 is fixed to the other end of the shaft 6 and has a shape extending along the axial direction of the shaft 6.
The second energy applying unit 92 applies ultrasonic energy to the target site under the control of the control device 3. The second energy application unit 92 includes a probe 921 (FIG. 1) and an ultrasonic transducer 922 (see FIG. 2).

The probe 921 is a columnar body made of a conductive material and extending along the axial direction of the shaft 6. As shown in FIG. 1, the probe 921 is inserted into the shaft 6 with one end side (right end side in FIG. 1) exposed to the outside, and an ultrasonic transducer 922 is attached to the other end. . The probe 921 contacts the target part when the target part is sandwiched between the first and

second holding members

8 and 9, and the ultrasonic vibration generated by the ultrasonic vibrator 922 is applied to the target part. Transmit (apply ultrasonic energy to the target site).
The ultrasonic vibrator 922 is configured by, for example, a piezoelectric vibrator that uses a piezoelectric element that expands and contracts when an AC voltage is applied. The ultrasonic vibrator 922 is joined with ultrasonic lead wires C3 and C3 ′ (see FIG. 2) constituting the electric cable C, and an AC voltage is applied under the control of the control device 3. Generates ultrasonic vibration.
Although not specifically shown, a vibration expanding member such as a horn for expanding the ultrasonic vibration generated by the ultrasonic vibrator 922 is interposed between the ultrasonic vibrator 922 and the probe 921.
Here, the configuration of the second energy applying unit 92 may be a configuration in which the probe 921 is longitudinally vibrated (vibration in the axial direction of the probe 921), or the probe 921 is laterally vibrated (in the radial direction of the probe 921). (Vibration).

[Configuration of control device and foot switch]
FIG. 2 is a block diagram illustrating a configuration of the control device 3.
In FIG. 2, the main part of the present invention is mainly illustrated as the configuration of the control device 3.
The foot switch 4 is a part operated by the operator with his / her foot, and outputs an operation signal to the control device 3 in response to the operation (ON). And the control apparatus 3 starts the joining control mentioned later according to the said operation signal.
The means for starting the joining control is not limited to the foot switch 4, and other switches that are operated by hand may be employed.

The control device 3 comprehensively controls the operation of the treatment instrument 2. As shown in FIG. 2, the control device 3 includes a high-frequency energy output unit 31, a first sensor 32, a thermal energy output unit 33, a vibrator drive unit 34, a second sensor 35, a control unit 36, Is provided.
The high-frequency energy output unit 31 supplies high-frequency power between the heat transfer plate 821 and the probe 921 via the high-frequency lead wires C1 and C1 ′ under the control of the control unit 36.
The first sensor 32 detects a voltage value and a current value supplied from the high-frequency energy output unit 31 to the heat transfer plate 821 and the probe 921. Then, the first sensor 32 outputs a signal corresponding to the detected voltage value and current value to the control unit 36.

The thermal energy output unit 33 applies (energizes) a voltage to the heat generating sheet 822 via the heat generating lead wires C2 and C2 ′ under the control of the control unit.
The vibrator driving unit 34 applies an AC voltage to the ultrasonic vibrator 922 via the ultrasonic lead wires C3 and C3 ′ under the control of the control unit 36.
The second sensor 35 detects a voltage value and a current value applied to the ultrasonic transducer 922 from the transducer driving unit 34. Then, the second sensor 35 outputs a signal corresponding to the detected voltage value and current value to the control unit 36.

The control unit 36 includes a CPU (Central Processing Unit) and the like, and executes joining control according to a predetermined control program when the foot switch 4 is turned on. As illustrated in FIG. 2, the control unit 36 includes an energy control unit 361, a first impedance calculation unit 362, a second impedance calculation unit 363, and a load control unit 364.
The energy control unit 361 is a high-frequency energy output unit according to the operation signal from the foot switch 4, the target portion calculated by the first and second

impedance calculation units

362 and 363, and the impedances of the ultrasonic transducer 922, respectively. 31, controls the operation of the thermal energy output unit 33 and the vibrator driving unit 34. That is, the energy control unit 361 controls the timing at which the first and second

energy applying units

82 and 92 apply high frequency energy, ultrasonic energy, and thermal energy to the target part.

The first impedance calculation unit 362 calculates the impedance of the target part when high frequency energy is applied to the target part based on the voltage value and the current value detected by the first sensor 32.
Based on the voltage value and current value detected by the second sensor 35, the second impedance calculation unit 363 calculates the impedance of the ultrasonic transducer 922 when ultrasonic energy is applied to the target region. To do.
The load control unit 364 operates the motor 11 based on the impedance of the ultrasonic transducer 922 calculated by the second impedance calculation unit 363 and compresses the target portion from the first and

second holding members

8 and 9. The load (the force for clamping the target part by the first and second holding members 8 and 9) is increased.

[Operation of medical treatment device]
Next, operation | movement of the medical treatment apparatus 1 mentioned above is demonstrated.
In the following, as an operation of the medical treatment apparatus 1, joining control by the control apparatus 3 will be mainly described.
FIG. 3 is a flowchart showing joining control by the control device 3.
The surgeon grasps the treatment instrument 2 and inserts the distal end portion of the treatment instrument 2 (a part of the clamping portion 7 and the shaft 6) into the abdominal cavity through the abdominal wall using, for example, a trocar. Then, the surgeon operates the operation knob 51 to open and close the first and

second holding members

8 and 9, and pinch the target portion with the first and second holding members 8 and 9 (step S1: pinching step) ).
Then, the surgeon operates (ON) the foot switch 4 to start the joining control by the control device 3.

When the operation signal from the foot switch 4 is input (when the foot switch 4 is turned ON) (step S2: Yes), the energy control unit 361 drives the high frequency energy output unit 31 and the high frequency energy output unit 31. Starts supplying high-frequency power to the heat transfer plate 821 and the probe 921 (starts applying high-frequency energy to the target part) (step S3: first application step).
After step S3, the first impedance calculator 362 starts calculating the impedance of the target part based on the voltage value and the current value detected by the first sensor 32 (step S4).

FIG. 4 is a diagram showing the behavior of the impedance of the target part calculated after step S4.
When high frequency energy is applied to the target part, the impedance of the target part exhibits the behavior shown in FIG.
In the initial time zone in which high-frequency energy is applied (from the start of applying high-frequency energy to time t1), the impedance of the target portion gradually decreases as shown in FIG. This is due to the fact that the cell membrane destruction of the target site occurs due to the application of the high frequency energy, and the extracellular matrix is extracted from the target site. In other words, the initial time zone is a time zone in which the extracellular matrix is extracted from the target site, and the viscosity of the target site decreases (the target site softens).

Then, after the time t1 when the impedance of the target part becomes the minimum value VL, the impedance of the target part gradually increases as shown in FIG. This is due to the fact that Joule heat acts on the target site by applying high-frequency energy, and the target site itself generates heat, thereby reducing (evaporating) moisture in the target site. In other words, after the time t1, the extracellular matrix is no longer extracted from the target site, the moisture in the target site evaporates due to heat generation, and the viscosity of the target site increases (the target site coagulates). It is a time zone.

After step S4, the energy control unit 361 constantly monitors whether or not the impedance of the target portion calculated by the first impedance calculation unit 362 has reached the minimum value VL (step S5).
When it is determined that the impedance of the target region has reached the minimum value VL (step S5: Yes), the energy control unit 361 drives the transducer driving unit 34, and from the transducer driving unit 34 to the ultrasonic transducer 922. Application of the AC voltage is started (application of ultrasonic energy to the target region is started) (step S6: second application step).
After step S6, the second impedance calculator 363 starts calculating the impedance of the ultrasonic transducer 922 based on the voltage value and the current value detected by the second sensor 35 (step S7).

FIG. 5 is a diagram showing the behavior of the impedance of the ultrasonic transducer 922 calculated after step S7.
When ultrasonic energy is applied to the target site, the impedance of the ultrasonic vibrator 922 exhibits the behavior shown in FIG.
By the way, the impedance of the ultrasonic transducer 922 increases in accordance with the load applied to the probe 921 when the target part is held between the first and

second holding members

8 and 9.
As described above, when high frequency energy or ultrasonic energy is applied to the target portion, the internal moisture evaporates and the viscosity increases. For this reason, the load applied to the probe 921 gradually increases because the target site coagulates after time t1. That is, the impedance of the ultrasonic transducer 922 gradually increases as shown in FIG.

After step S7, the energy control unit 361 constantly monitors whether or not the impedance of the ultrasonic transducer 922 calculated by the second impedance calculation unit 363 has reached a predetermined value Th (FIG. 5) (step S8). ).
If it is determined that the impedance of the ultrasonic transducer 922 has reached the predetermined value Th (step S8: Yes), the energy control unit 361 stops driving the high-frequency energy output unit 31 and the transducer drive unit 34 (target region). The application of the high-frequency energy and the ultrasonic energy is terminated) (step S9).

After step S9, the load control unit 364 operates the motor 11 to increase the compression load applied to the target part from the first and second holding members 8 and 9 (step S10).
After step S10, the energy control unit 361 drives the thermal energy output unit 33 and starts application (energization) of voltage from the thermal energy output unit 33 to the heat generating sheet 822 (starts application of thermal energy to the target part). (Step S11: third grant step).
After step S11, the energy control unit 361 constantly monitors whether or not a predetermined time has elapsed since the application of thermal energy in step S11 (step S12).
If it is determined that the predetermined time has elapsed (step S12: Yes), the energy control unit 361 stops driving the thermal energy output unit 33 (ends the application of thermal energy to the target part) (step S13). ).
The target part is joined by the above treatment.

FIG. 6 is a time chart showing the types of energy applied in the first to third periods and the compressive load applied to the target part during the joining control shown in FIG.
As described above, the timing at which the high-frequency energy, the ultrasonic energy, and the thermal energy are applied and the timing at which the compression load applied to the target portion is changed are summarized as shown in FIG.
That is, in the first period T1 from when the foot switch 4 is turned on to the time t1, only the high frequency energy is applied to the target part as shown in FIG. Moreover, in this 1st period T1, the compressive load given to an object site | part from the 1st, 2nd holding

members

8 and 9 is a comparatively low load (for example, about 0.2 MPa).
Further, in the second period T2 from time t1 to time t2, as shown in FIG. 6, both high-frequency energy and ultrasonic energy are applied to the target part. Moreover, in this 2nd period T2, the compressive load given to an object site | part from the 1st, 2nd holding

members

8 and 9 is the same load as 1st period T1.
Then, only the thermal energy is applied to the target portion in the third period T3 from the time t2 until the predetermined time determined in step S12 elapses. In the third period T3, the compressive load applied to the target part from the first and

second holding members

8 and 9 is higher than the compressive load in the first and second periods T1 and T2.

Here, as described above, the medical treatment apparatus 1 according to the first embodiment has the first and second holding members 8 when the target site is sandwiched between the first and

second holding members

8 and 9. , 9 to increase the compressive load applied to the target part in the third period T3 than in the first and second periods T1, T2.
That is, when the extracellular matrix is coagulated (third period T3), a strong joint can be realized by increasing the compressive load applied to the target site. In addition, when the extracellular matrix is extracted and stirred (first and second periods T1 and T2), the extracted extracellular matrix is reduced to be the first and second holding members 8 by reducing the compression load applied to the target site. , 9 can be prevented from flowing out. Further, the higher the compressive load applied to the target site when the extracellular matrix is stirred, the more ultrasonic energy (ultrasonic vibration) is transmitted to the first jaw 81 without being transmitted to the target site. By reducing the compressive load in this manner, ultrasonic energy (ultrasonic vibration) can be efficiently transmitted to the target site.

After the medical treatment apparatus 1 according to the first embodiment described above holds the target part between the first and

second holding members

8 and 9, the high-frequency energy is applied to the target part in the first period T1. The ultrasonic energy is applied in the second period T2 after the first period T1, and the thermal energy is applied in the third period T3 after the second period T2. That is, by applying high-frequency energy in the first period T1, the cell membrane of the target site is destroyed and the extracellular matrix is extracted, and by applying ultrasonic energy in the second period T2, the extracellular matrix is stirred and intertwined closely. The extracellular matrix is solidified by the application of thermal energy in the third period T3.
Therefore, according to the medical treatment apparatus 1 according to the first embodiment, it is possible to appropriately execute the three processes of extraction, stirring, and coagulation of the extracellular matrix necessary for joining the target parts, There is an effect that the bonding strength can be improved.

Further, the medical treatment device 1 according to the first embodiment starts the second period T2 and applies ultrasonic energy to the target site when the impedance of the target site reaches the minimum value VL.
For this reason, it is possible to appropriately set the first period T1 in which high-frequency energy is applied to the target site, and to extract a sufficient amount of extracellular matrix from the target site, so that the stirring process can be performed. The bonding strength can be further improved.

The medical treatment apparatus 1 according to the first embodiment starts the third period T3 when the impedance of the ultrasonic transducer 922 reaches the predetermined value Th, and applies thermal energy to the target site. To do.
For this reason, it is possible to appropriately set the second period T2 in which the ultrasonic energy is applied to the target region, and to sufficiently perform the coagulation process after the extracellular matrix is sufficiently stirred. Can be further improved.

(Modification of Embodiment 1)
FIG. 7 is a diagram showing a modification of the first embodiment of the present invention. Specifically, FIG. 7 is a flowchart showing the joining control in this modification.
In the first embodiment described above, the application of ultrasonic energy to the target part is started based on the impedance of the target part, and the application of thermal energy to the target part is started based on the impedance of the ultrasonic vibrator 922 (the target part). However, the present invention is not limited to this, and the application of each energy may be started when a predetermined time has elapsed as in the present modification.
That is, in the present modification, the first and second sensors 32 and 35 and the first and second

impedance calculation units

362 and 363 are omitted. In the joining control in this modification, as shown in FIG. 7, the impedances of the target portion and the ultrasonic transducer 922 are calculated with respect to the joining control described in the first embodiment (FIG. 3). Related steps S4, S5, S7, and S8 are omitted, and steps S14 and S15 are added.

Step S14 is executed after step S3.
Specifically, in step S14, the energy control unit 361 constantly monitors whether or not a predetermined time has elapsed since the application of the high frequency energy in step S3.
Here, the predetermined time is a time set as follows.
That is, steps S3 to S5 are respectively executed in advance for a plurality of other biological tissues. Then, the time from when the application of the high frequency energy is started until the impedance of the target part reaches the minimum value VL is acquired, and the average value of the acquired times is set as the predetermined time determined in step S14.
And when it is judged that predetermined time passed since provision of high frequency energy (step S14: Yes), the control apparatus 3 transfers to step S6.

Step S15 is executed after step S6.
Specifically, in step S15, the energy control unit 361 constantly monitors whether or not a predetermined time has elapsed since the application of ultrasonic energy in step S6.
Here, the predetermined time is a time set as follows.
That is, Steps S3 to S8 are respectively executed for a plurality of other biological tissues in advance. Then, the predetermined time in which the time from when the application of ultrasonic energy is started until the impedance of the ultrasonic transducer 922 reaches the predetermined value Th is determined, and the average value of the acquired respective times is determined in step S15. Set as.
And when it is judged that predetermined time passed since provision of ultrasonic energy (step S15: Yes), the control apparatus 3 transfers to step S9.

According to this modification described above, the same effects as those of the first embodiment described above can be obtained, and the configuration can be simplified by omitting the first and second sensors 32 and 35 and the first and second

impedance calculation units

362 and 363. Can be achieved.

(Embodiment 2)
Next, a second embodiment of the present invention will be described.
In the following description, the same reference numerals are given to the same components as those in the first embodiment described above, and detailed description thereof will be omitted or simplified.
In the medical treatment apparatus 1 according to the first embodiment described above, the motor 11 and the load control unit 364 are automatically employed as a configuration for increasing the compressive load applied to the target site when the application of thermal energy is started. The compression load was increased.
On the other hand, the medical treatment apparatus according to the second embodiment is configured to manually increase the compression load applied to the target site when the application of thermal energy is started.
Hereinafter, the configuration of the medical treatment apparatus according to the second embodiment and the bonding control will be described.

[Configuration of medical treatment device]
FIG. 8 is a block diagram showing a configuration of a medical treatment apparatus 1A according to Embodiment 2 of the present invention.
As shown in FIG. 8, the medical treatment apparatus 1A according to the second embodiment has a motor 11 and a load compared to the medical treatment apparatus 1 (FIGS. 1 and 2) described in the first embodiment. The control unit 364 is omitted. Further, the medical treatment apparatus 1A has a lock mechanism 12 and a lock mechanism drive unit 13 added to the medical treatment apparatus 1 described in the first embodiment, and also has a function of the control unit 36. Department has been changed.

FIG. 9 is a diagram illustrating the function of the lock mechanism 12. Specifically, FIG. 9 is a diagram showing a treatment instrument 2A according to the second embodiment.
The lock mechanism 12 is provided inside the handle 5 and switches the operation knob 51 to an allowable state or a restricted state.
Specifically, the lock mechanism 12 is mechanically connected (locked) to the operation knob 51 or the opening / closing mechanism 10 in the restricted state, so that the first position P1 (FIG. 9) in the operation knob 51 is changed to the second position. The movement to P2 (FIG. 9) is restricted. Further, in the permissible state, the lock mechanism 12 is released from the mechanical connection (lock) with the operation knob 51 or the opening / closing mechanism 10 and allows the operation knob 51 to move.

Here, the first position P1 is the following position.
When the operation knob 51 is moved from the initial position (the position of the operation knob 51 shown in FIG. 9) to the first position P1, the first holding member 8 is moved in a direction approaching the second holding member 9. A relatively low compressive load (first compressive load (for example, about 0.2 MPa)) is applied to the target portion that rotates and is sandwiched between the second holding member 9. That is, the 1st position P1 is a position which gives the 1st compressive load to an object part.
The second position P2 is the following position.
When the operation knob 51 moves from the first position P1 to the second position P2, the first holding member 8 rotates in a direction closer to the second holding member 9, and the second holding member 9 is rotated. A second compressive load higher than the first compressive load is applied to the target portion sandwiched between the two. That is, the 2nd position P2 is a position which gives the 2nd compression load to an object part.

In the second embodiment, the lock mechanism 12 is always urged so as to be mechanically connected (locked) to the operation knob 51 or the opening / closing mechanism 10 by an urging member such as a spring.
The lock mechanism drive unit 13 is provided inside the handle 5 and operates the lock mechanism 12 against the biasing force of a biasing member such as a spring under the control of the control device 3A (control unit 36A). Thus, the operation knob 51 is switched from the restricted state to the permitted state.

As shown in FIG. 8, the control unit 36 </ b> A has a load control unit 364 omitted and a lock mechanism control unit 365 added to the control unit 36 (FIG. 2) described in the first embodiment. Has been.
The lock mechanism control unit 365 drives the lock mechanism drive unit 13 based on the impedance of the ultrasonic transducer 922 calculated by the second impedance calculation unit 363, and switches the operation knob 51 from the restricted state to the allowed state.

[Joint control]
Next, the joining control according to the second embodiment will be described.
FIG. 10 is a flowchart showing joining control by the control device 3A.
In the joining control according to the second embodiment, as shown in FIG. 10, step S10 related to the operation of the motor 11 is omitted with respect to the joining control (FIG. 3) described in the first embodiment. Steps S16 and S17 are added.

As described above, when the lock mechanism drive unit 13 is not driven, the lock mechanism 12 is urged by a biasing member such as a spring so as to be mechanically connected to the operation knob 51 or the opening / closing mechanism 10. (The operation knob 51 is set to a restricted state). For this reason, in step S1 in the second embodiment, the operator moves the operation knob 51 from the initial position to the first position P1, and sandwiches the target region with the first and

second holding members

8 and 9. To do. That is, the first compressive load is applied to the target part.

Step S16 is executed after step S9.
Specifically, the lock mechanism controller 365 determines in step S16 that the impedance of the ultrasonic transducer 922 has reached the predetermined value Th in step S8 (step S8: Yes). 13 is driven to switch the operation knob 51 from the restricted state to the permitted state.
After step S16, the surgeon moves the operation knob 51 from the first position P1 to the second position P2 (step S17). That is, a second compressive load higher than the first compressive load is applied to the target portion.
Then, after step S17, the control device 3A proceeds to step S11.

According to the second embodiment described above, the following effects are obtained in addition to the same effects as those of the first embodiment.
1 A of medical treatment apparatuses which concern on this Embodiment 2 employ | adopt the lock mechanism 12 as a structure which increases the compressive load given to an object site | part when starting provision of a thermal energy, and the structure which increases manually It is said.
For this reason, compared with the medical treatment apparatus 1 using the motor 11 demonstrated in Embodiment 1 mentioned above, the medical treatment apparatus 1A can be manufactured at low cost.

(Modification of Embodiment 2)
In the second embodiment described above, application of ultrasonic energy or thermal energy is started when a predetermined time has passed as in the modification of the first embodiment described above (FIG. 7) (the operation knob 51 is in a restricted state). May be adopted.

Moreover, in Embodiment 2 mentioned above, you may provide the alerting | reporting part which alert | reports having switched the operation knob 51 from the restriction | limiting state to the permission state in 1 A of medical treatment apparatuses.
Examples of the notification unit include a configuration in which notification is performed by lighting an LED (Light Emitting Diode) or the like, a configuration in which notification is performed by displaying a message, a configuration in which notification is performed by sounding sound, and the like.

(Other embodiments)
The embodiments for carrying out the present invention have been described so far, but the present invention should not be limited only by the above-described first and second embodiments and their modifications.
In the first and second embodiments and the modifications described above, the first energy applying unit 82 is provided on the first holding member 8 and the second energy applying unit 92 is provided on the second holding member 9. If it is the structure which can give not only the high frequency energy, the ultrasonic energy, and the heat energy to the target part, the energy applying unit that applies each energy only to one of the first and

second holding members

8, 9. You may employ | adopt the structure which provided. Or you may be the structure which provided each energy provision part in both the 1st, 2nd holding

members

8 and 9. FIG. For example, the heat generating sheet 822 and the heat transfer plate 821 may be formed on the probe 921.

In the first and second embodiments and the modifications described above, high-frequency energy is applied in the first and second periods T1 and T2, ultrasonic energy is applied in the second period T2, and thermal energy is applied in the third period T3. However, the present invention is not limited to this. As long as the configuration is such that high-frequency energy is applied at least in the first period T1, ultrasonic energy is applied at least in the second period T2, and thermal energy is applied at least in the third period T3, Similarly to the second period T2 in these modified examples, two or more types of energy may be simultaneously applied at any point in time.

In the first and second embodiments and the modifications described above, the heat generating sheet 822 is employed as a configuration for applying thermal energy to the target portion, but the present invention is not limited thereto. For example, a configuration is adopted in which a plurality of heat generating chips are provided on the heat transfer plate 821, and the heat of the plurality of heat generating chips is transmitted to the target site via the heat transfer plate 821 by energizing the plurality of heat generating chips. (For example, refer to JP2013-106909A for this technique).

In the first and second embodiments and the modifications described above, application of ultrasonic energy and thermal energy is started based on the impedance and time of the target site and the ultrasonic vibrator 922, and the compression load applied to the target site. Although the timing for increasing the frequency has been adjusted, the present invention is not limited to this. For example, the above-described timing may be adjusted based on a physical property value such as hardness, thickness, or temperature of the target portion.

In the first and second embodiments described above, the application of ultrasonic energy is started when the impedance of the target portion reaches the minimum value VL, but the present invention is not limited to this. After the time t1 when the impedance of the target region becomes the minimum value VL (for example, from the time t1 to the time t1 ′ (FIG. 4) when returning to the initial value VI (FIG. 4) when the application of high-frequency energy is started. If so, the application of ultrasonic energy may be started at any timing.

In addition, the flow of bonding control is not limited to the processing order in the flowcharts (FIGS. 3, 7, and 10) described in the first and second embodiments and the modifications described above, and can be changed within a consistent range. It doesn't matter.

DESCRIPTION OF

SYMBOLS

1,1A

Medical treatment apparatus

2,2A Treatment tool 3,3A Control apparatus 4 Foot switch 5 Handle 6 Shaft 7 Clamping part 8 First holding member 9 Second holding member 10 Opening / closing mechanism 11 Motor 12 Lock mechanism 13 Lock mechanism drive part 31 High-frequency energy output unit 32 First sensor 33 Thermal energy output unit 34 Transducer drive unit 35 Second sensor 36, 36A Control unit 51 Operation knob 81 First jaw 82 First energy application unit 91 Second jaw 92 Second energy application Unit 361 energy control unit 362 first impedance calculation unit 363 second impedance calculation unit 364 load control unit 365 lock mechanism control unit 811 shaft support unit 812 support plate 821 heat transfer plate 822 heat generating sheet 921 probe 922 ultrasonic transducer 8211 treatment surface C Electric cable C1, C1 'High circumference Lead wire C2, C2 'Heat generation lead wire C3, C3' Ultrasonic lead wire P1 First position P2 Second position R1-R3 Arrow t1, t2, t1 'Time T1 First period T2 Second period T3 3rd period Th Predetermined value VI Initial value VL Minimum value

Claims

A pair of holding members for sandwiching a target site for bonding in a living tissue; and
Provided on at least one of the pair of holding members, and when the target part is clamped by the pair of holding members, contacts the target part and imparts energy to the target part An energy applying unit that performs
High-frequency energy is applied from the energy application unit to the target part in a first period, ultrasonic energy is applied in a second period after the first period, and a third period after the second period. An energy control unit for applying thermal energy with
A medical treatment device comprising:
A first impedance calculator that calculates an impedance of the target part when high-frequency energy is applied to the target part;
The energy control unit starts the second period after the impedance of the target portion calculated by the first impedance calculation unit reaches a minimum value, and the energy control unit supercedes the target portion from the energy applying unit. The medical treatment apparatus according to claim 1, wherein sonic energy is applied.
The energy applying unit includes an ultrasonic transducer that applies ultrasonic energy to the target part,
The medical treatment apparatus further includes a second impedance calculation unit that calculates an impedance of the ultrasonic transducer when ultrasonic energy is applied to the target site,
The energy control unit starts the third period when the impedance of the ultrasonic transducer calculated by the second impedance calculation unit reaches a predetermined value. The medical treatment apparatus according to claim 1, wherein thermal energy is applied to the medical treatment apparatus.
A load control unit that switches a compression load applied to the target part from the pair of holding members when the target part is sandwiched between the pair of holding members;
The medical load according to any one of claims 1 to 3, wherein the load control unit sets the compression load to a different load in the first period, the second period, and the third period. Treatment device.
The medical load according to claim 4, wherein the load control unit sets the compressive load in the third period to a load higher than the compressive load in the first period and the second period. Treatment device.
The pair of holding members are relative to a first position that applies a first compressive load to the target portion and a second position that applies a second compressive load higher than the first compressive load to the target portion. Configured to be movable,
The medical treatment apparatus is in an allowable state in which relative movement from the first position to the second position by the pair of holding members is allowed, or from the first position to the second position. A lock mechanism that switches to a restricted state that restricts the relative movement of the lock mechanism, and a lock mechanism control unit that operates the lock mechanism,
The lock mechanism control unit sets the restricted state in the first period and the second period, and sets the permitted state in the third period. The medical treatment device described in 1.
After the target region to be joined in the living tissue is sandwiched between the pair of holding members, high frequency energy is applied to the target region from at least one of the pair of holding members in the first period. A first granting step;
A second application step of applying ultrasonic energy to the target part from at least one of the pair of holding members in the second period after the first period;
A third application step of applying thermal energy to the target part from at least one of the pair of holding members in a third period after the second period;
A method for operating a medical treatment apparatus, comprising:
A sandwiching step of sandwiching a target site for joining in a living tissue with a pair of holding members;
A first application step of applying high-frequency energy to the target part from at least one of the pair of holding members in the first period;
A second application step of applying ultrasonic energy to the target part from at least one of the pair of holding members in the second period after the first period;
A third application step of applying thermal energy to the target part from at least one of the pair of holding members in a third period after the second period;
A treatment method comprising the steps of: